Recovery From Schizophrenia: Psychiatry And Political Economy

WHAT IS SCHIZOPHRENIA? 21Brain structureThat there are biochemical differences in schizophrenia is certain—just as certainas that there are biochemical correlates in the brain to rage, anxiety and learningSpanish. That there are anatomical differences in the brains of people withschizophrenia (as in some organic brain disorders) is not a foregone conclusion,however, and in fact the evidence for such abnormalities in the structure of thebrain has been slow in accumulating. Decades of post-mortem study of the brainsof schizophrenics failed to produce agreement on any neuroanatomical changesspecific to the illness. The application of more advanced research techniques,however, has shown indications of injury in an area of the brain known as the limbicsystem. Several researchers have identified such degenerative changes in peoplewith schizophrenia, which were not evident in those who were free of the illness. 42These findings are of interest as they point to abnormalities in the same area ofthe brain (the limbic system) that neurochemical research has incriminated asfunctioning abnormally in schizophrenia. This interconnecting network ofterminals and tracts is believed to be central to the regulation of emotion and tothe individual’s response to stress.Important evidence for anatomical changes in the brain in schizophrenia hasbeen provided by computed tomographic (CT) scans and magnetic resonanceimaging (MRI). Scores of studies using CT scans and MRI have found evidenceof mild cerebral atrophy in a proportion of people with schizophrenia. 43 Thechanges, which include enlargement of the fluid-containing ventricles of the brainand widening of the fissures between folds of brain tissue, can also occur indegenerative brain conditions and in some other psychiatric patients. 44The cause of such cerebral atrophy in schizophrenia is not known. Since theabnormalities are found equally in people with first-break, acute schizophreniaand in those with chronic illness, it is unlikely that the changes are due totreatment. 45 The atrophy does not indicate that schizophrenia is a degenerativebrain disease; it is not progressive, it is not specific to schizophrenia, nor is itpresent in all cases. 46 The changes occur in only about a quarter of people withschizophrenia, but there is not a well-defined group with enlarged cerebralventricles and another with normal-size ventricles; the CT-scan and MRIchanges are distributed along a smooth gradient from normal to large. 47 The mostprobable explanation is that the cerebral atrophy found in some people withschizophrenia is an indicator of some earlier non-specific brain injury thatincreases the vulnerability to developing the illness. Such brain damage mightresult, for example, from intrauterine oxygen deprivation or infection, birthtrauma or one of a number of similar assaults.It is likely that inheritance and early brain damage are both risk factors forschizophrenia and that the two together create double jeopardy. Studies ofidentical twins show that if one twin has schizophrenia and the other does not,the one with the illness is more likely to have a history of obstetric complications